1. The Sociology of Health, Illness and Medicine

2. Topics in Medical Sociology: Epidemiology Public health efforts and other policy issues Formal organizational aspects of healthcare Social and cultural influences on health and illness The socialization of caregivers “Micro-politics” among practitioners in healthcare Caregiver-patient interaction

3. Epidemiology Epidemiology is the study of the extent and population-based spread of disease. Epidemiologists might examine genetic, biological and physical environmental factors in addition to social factors. Some examples of the uses of epidemiology: –AIDS, TB and other communicable diseases –Hantavirus, "Mad Cow" (SJV) and other animal-borne diseases –Mental illness and its environmental correlates... and many others. Epidemiology is an important tool for managing public health.

4. Public Health Efforts and their Impact on Death and Disease Doctors treat "patients"; public health officers treat communities and societies. People tend to consider new medical "breakthroughs" in contributing to reductions in mortality and morbidity. However, public health and "social hygiene" efforts have contributed far more to health than have medical measures: –In 1900, 44% of deaths in N America were due to 11 infectious diseases. –By 1980, that figure was less than 5%. –Nowadays, most deaths are due to the three major chronic conditions: heart disease, cancer and stroke.

5. The Organization of Healthcare Healthcare services serve two functions: Direct service functions, and supportive or ancillary functions. Direct Service: –Individual, patient-based care –Community-based care Ancillary functions: –Finance –Suppliers –Regulation –Representation –Research –Consulting

6. Social and Cultural Impacts on Health One's position in a social structure influences one's health in numerous ways. –Gender –Socioeconomic status –Occupation –Race and ethnicity –Age

7. Social and Cultural Impacts on Health All of these factors influence –1. Differential exposure to pathogenic or salutary circumstances – 2. Vulnerabilty to disease – 3. Access to healthcare resources

8. The Socialization of Caregivers Focus on doctors: Student doctors acquire knowledge to accomplish "hypothesis testing" in medical encounters.

9. The Socialization of Caregivers Medical school is thus a period of socialization in which students acquire new competencies. What about informal socialization? –Doctors learn about professional hierarchies. –Doctors learn to think of patients "objectively," ie: "Don't let emotions get in the way“ The patient is an "object," an organism that provides data –Doctors acquire sense of selves in the world

10. Medical Micropolitics Medical care is NOT doctor care. –Nurses –Physiotherapists –Counsellors –Volunteers –Orderlies Doctors are "team leaders.“ The "Doctor-Nurse Game": How nurses orient to doctors to perform work but still preserve hierarchy

11. Caregiver-Patient Interaction Focus on Doctor-Patient Hypothesis-testing approach: Doctor asks questions; patient answers. Medical interviewing instruction reinforces this.

12. Caregiver-Patient Interaction Patient's role: –Answer questions. –Don't speak unless spoken to. –Don't ask questions. –Don't offer diagnoses. However, medical complaints are often cast as questions or as "candidate diagnoses." Doctors SHOULD learn to listen and to encourage questioning and talk on patients' part.